Rethinking the concept of an energy availability threshold and its role in the Female Athlete Triad

Mary Jane De Souza, Kristen J. Koltun, Nicole CA Strock, Nancy I. Williams

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


The scientific foundations of the Female Athlete Triad model include low energy availability (or energy deficiency) presenting with or without disordered eating, menstrual dysfunction, and poor bone health. Energy availability has been highlighted in the etiology of menstrual disorders and bone loss; a specific threshold of energy availability below which negative effects occur has been prominent in the framework of the Female Athlete Triad. This brief review will provide an overview of the Female Athlete Triad as represented by the scientifically rigorous evidence available to date. This review will focus on new findings regarding energy availability, specifically the validity of a particular energy availability threshold associated with menstrual disruption. Our findings to date do not support the use of an absolute energy availability threshold of 30 kcal/kg FFM/day as a strategy to prevent the occurrence of abnormal menstrual cycles. We propose that a sliding scale range should be considered for a given individual such that if energy availability decreases, the likelihood of a menstrual abnormality increases. We also caution against the use of self-report methods for assessing energy availability and encourage the use of repeated serial objective physiological assessments in free-living individuals. This review highlights the presence of individual variability in the level of energy availability at which the susceptibility to menstrual disruption is observed and calls for a reconceptualization of how best to utilize measures of energy availability in exercising women, and how to consider revisions to position stands and consensus statements utilizing new data on the Female Athlete Triad.

Original languageEnglish (US)
Pages (from-to)35-42
Number of pages8
JournalCurrent Opinion in Physiology
StatePublished - Aug 2019

All Science Journal Classification (ASJC) codes

  • Physiology
  • Physiology (medical)


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